Indigenous foods used to address micronutrient deficiencies in rural Eastern Cape
The CSIR embarked on an integrated nutrition intervention pilot programme in five schools in Cofimvaba in the Eastern Cape with the aim of supporting government to provide nutrient rich food-stuff to improve the learning ability of learners. Researchers developed a nutritional drink from a combination of food products such as sorghum, soya, milk as well as local and indigenous leafy vegetables. CSIR researchers are currently evaluating the bio-accessibility of the micronutrients in the drink to the human body to determine the nutritional value of the drink.
The South African National Health and Nutrition Examination Survey conducted in 2012 found that nutritional deficiencies are still prevalent in children in rural and urban areas with an average of 43% children being vitamin A-deficient and 11% iron-deficient. Although these figures show slight improvement from the previous surveys (1999 and 2008), they still point to a health challenge that requires a long-term sustainable solution.
In an effort to improve dietary intake of vitamin A and iron, among other micronutrients, the Department of Health implemented a mandatory national food fortification programme in 2013, which requires that selected micronutrients are added to local maize and wheat flour. However, despite considerable efforts to improve dietary intake and a commitment from the government to provide quality education, a significant number of students across rural South Africa still have diets lacking in micronutrients. Nutrient-poor diets can lead to nutritional problems, such as iron-deficiency anaemia, that can adversely affect attention and learning in school.
Baseline studies involving five schools in Cofimvaba were conducted in August 2013 with a focus on three micronutrients (vitamin A, iron and zinc) which had been identified by a national survey on nutrition as being inadequate in children living in rural areas. The assessment of nutrient intake included a 24-hour recall of food intake, food frequency, biochemical tests and anthropometrics (body measurements). The baseline studies indicated that chronic and acute malnutrition was mainly prevalent in girls, with the incidence of underweight recorded as 8.3%, wasting (too thin for their height) as 2.8% and stunting (too short for their age) as 5.6%. Overweight and obesity was not prevalent. Only 2.3% of the boys suffered from chronic malnutrition (growth stunting) and no acute malnutrition (underweight) was observed, but overweight was observed in 4.7% of the boys. Based on the children’s serum ferritin levels, a protein that stores and releases iron in the body, more than 90% of the children were diagnosed with low iron levels in their blood. Overall, these results indicate that the diets of households were not diversified, and lacked nutritious food items from some food groups, like fruits and vegetables, a key source of micronutrients.
A science-based intervention
The CSIR embarked on an integrated and comprehensive food and nutrition intervention in the selected schools to enhance nutrient intake of food provided in schools. The intervention included providing a nutritious breakfast drink, functional school garden and training and education for food handlers, learners and teachers. Over 1 800 students, mostly aged 7-12, from five schools in the poorest regions of the Eastern Cape received the breakfast drink. The breakfast drink is made from a combination of various pre-cooked food products such as sorghum, soya, milk as well as four other vegetables, including indigenous leafy vegetables which are dried ground to a powdered form and blended. The pre-mix powder is then mixed with water and served to the children each morning. The breakfast drink is a good source of vitamin A, zinc and iron and the researchers are currently testing the nutritional impact of the drink as part of the ongoing project.
Bio-accessibility can be defined as the quantity or fraction of food components which is released in the gastrointestinal tract and becomes available for absorption by the human body. The determination of nutritional content directly from foodstuff through laboratory testing is not enough for the accurate prediction of its potential absorption in the human body. Metabolites reaching the blood system may be different from the original compounds found in food as a result of metabolic activity (the breakdown of food into smaller absorbable constituents) that takes place during absorption. CSIR researchers are testing the bioaccessibility of micronutrients in the human body to establish the true nutritional efficacy of the food products used in this programme. This data will be used to improve the formula of the nutritional drink and can provide valuable information to determine the right amount for daily intake and the optimal food sources for better nutrition.
Dr Nomusa Dlamini